Patient Monitoring Technology (Crash Course)

capnography
measure or monitoring of exhaled CO2

Infarct
area of necrosis or death

SpCO2
non-invasive measurement of carbon monoxide sats of hemoglobin

SpO2
non-invasive measurement of o2 sats of hemoglobin

SpMet
non-invasive measurement of methemoglobin

monitoring used in prehospital
ECG & 12 lead
pulse ox
pulse CO ox
Capnography
methemoglobin monitoring
total hemoglobin monitoring
glucometry

Bipolar leads
L1(RA-,LA+)
L2(RA-,LL+)
L3(RA-,LL+)

12 lead advantages
diagnostic for ischemia, injury and infarct

Myocardial ischemia
receives inadequate o2
ECG:ST depression, inverted T waves, or peaked T waves

Myocardial injury
myocardial death(irreversible)
ECG:significant Q wave

Unipolar (augmented)leads
aVR, aVL,aVF

chest (precordial)leads
V1-V6

I See All Leads
inferior (2,3,aVF)
septal (V1,V2)
anterior (V3,V4)
lateral (V5,V6)

SpO2 values
normal- 95-100%
below 95%- suspect hypoxia, shock or respiratory compromise
below 90%- aggressive airway management, ventilatory support and high-flow o2 indicated

pulse ox indications
dyspnea or other indications of respiratory compromise
suspected hypoxia
ALOC
suspected shock, multi-system trauma
traumatic brain injury
suspected MI or stroke
pts receiving analgesics or sedation medications
any pt receiving supplemental o2 or PPV
possible identification of inapparent hypoxia after long bone fxs
use to maintain pts SpO2 at 95 or above

pulse ox limitations to inaccurate readings
hypoperfusion
anemia
CO poisoning
methemoglobinemia/cyanide poisoning

ETCO2 values
normal- 35-45mmHg
elevated- >45mmHg -indicates hypoventilation
decreased- <45mmHg -indicates hyperventilation

advantages of continuous ETCO2 monitoring
monitor ETT
monitor effectiveness of CPR
monitor adequacy of ventilations
improved management of pts w/increased ICP, especially if being ventilated

Methemoglobinemia monitoring indications
cyanosis unresolved by ox therapya
pts receiving IV nitrates, lidocaine, nitric acid
suspected cyanide exposure
any pt w/elevated SpCO levels

total hemoglobin monitoring
some SpO2 monitors can measure total hemoglobin concentrations and help identify pts w/dehydration or hemorrhage

high SpHb
suspect dehydration

low SpHb
suspect hemorrhage, anemia